Question

this task will require you to reflect upon and analyse a written healthcare scenario from an ethico -legal perspective, using Driscoll’s reflective model as a guide. It is expected that you willdraw upon the unit content, personal experiences and relevant literature and learning resources to inform your reflection and analysis.

demonstrates an understanding of the ethico-legal complexities inherent in the situation, and considers the implications of different courses of action (40%)

demonstrates familiarity with key concepts of ethical practice (covered in this unit) pertaining to the chosen situation (10%)

Shows evidence of developing ethical awareness and how self-reflection may inform your practice and relationships with others (20%)

writes clearly and succinctly using Driscoll’s model (written in the first person), with correct grammar, ethico-legal terminology and referencing (Harvard style) (10%)

Integrates relevant literature and resources to support and justify key ideas and observations (20%)

CASE STUDY

Ruth is a 7-month-old baby who was born with Tetralogy of Fallot, a serious heart defect that can be corrected with surgery. Ruth had her first surgery - a shunt between the aorta and pulmonary artery to provide adequate blood flow to her lungs-when she was 2 months old. The complete repair of her heart will be performed when she is strong enough and her condition is stable enough to tolerate the stress of a more complicated operation. Her local physician and the paediatric cardiovascular surgeon at the medical centre estimate that Ruth will not be ready for surgery for several months, perhaps a year. Despite the earlier surgery, Ruth's heart functions inefficiently. As a result, her lungs frequently fill with fluid and she turns blue and becomes extremely short of breath. When this happens, her parents must rush her from their farm to the nearest hospital in a small town about 15 minutes away. In the Accident and Emergency Ward (A & E) she is usually given oxygen and medicines to help her breathe more easily and remove the extra fluid from her lungs. Ruth’s parents, Sam and Maddi Phillips, have had to rush her to the A & E ward approximately once a week since she was born. Sam is 18 years old; Maddi is 17 years old. Neither has finished high school. They live with Sam’s father on his farm. In addition to helping his father on the farm, Sam works from midnight to 6 am. at a local grocery store, in order to make a little extra money. He is chronically sleep-deprived and exhausted. Maddi is also chronically tired, as Ruth's care makes demands on her day and night. Both parents are terribly frightened by Ruth's crises and fear they may not make it to the A & E ward in time. They have become very close to the health workers and depend on them for psychological as well as medical support. One night Ruth arrives to A & E in more distress than usual. The staff are working as fast as they can to give the drugs needed to save her life. One of the nurses caring for Ruth is inexperienced; she rarely works in A & E and has never worked with critically ill children. In the stress of the crisis, she grabs the adult rather than the paediatric vial of morphine (the narcotic given to help ease Ruth's breathing) and inadvertently gives Ruth an adult dose rather than the paediatric dose. As a result, Ruth receives ten times the recommended dosage. Because morphine is a powerful respiratory suppressant, Ruth suffers a respiratory arrest and stops breathing completely. The staff are present when Ruth experiences her respiratory arrest and immediately begin resuscitation. Within a few minutes they discover the cause of the arrest and promptly give Ruth a narcotic antagonist - a drug to reverse the effects of the morphine. The narcotic antagonist works quickly, and in less than a minute Ruth is breathing again. Meanwhile, the oxygen and medicines have had a positive effect, and her breathing, heart function, and general condition are much improved. The A & E registrar, Dr. Koh, approaches Maddi and Sam. Maddi begins to cry and through her tears she sobs, "This is just what we were scared would happen. She's getting worse, isn't she? That's why she stopped breathing, isn't it? I don't know what we would do if we couldn't count on you." Dr. Koh had intended to tell Sam and Maddi the true cause of Ruth’s respiratory arrest, but now she hesitates. Dr. Koh knows these parents well; she has personally resuscitated Ruth several times and has seen firsthand the parents' stress and the difficulty they usually experience coping with the alltoo-frequent crises her illness generates. Dr Koh wonders if it might be better not to tell Sam and Maddi about the medication error, as they may lose faith in the hospital. She is worried that the next time Ruth has an episode, they may decide to take her to another hospital half an hour further away. Any delay in resuscitating Ruth could cause death or irreversible brain damage.

Answer 1

Question no 1

I believed that quality nursing care is about caring for your patients at a good quality standard. Nurses themselves have some values and know what values are. I feel for good quality nursing care you should be approachable to talk to and professionally and personally to your patients. To be confident with your patients and you wouldn’t want them to feel that your nor confident in what you’re doing or helping them with. Be respectful, patient, and caring making it a safe place for patients if they feel like they need to speak to you about personal stuff 1-1. Good nursing quality care should be companionate, smile when talking to them, making good relationships with others so when needed they have you there for a pat on the back. Being aware of their behaviour changes even if your busy. Ethical be truthful and honest to them don’t sugar coat any issues they need to know about. Your body language is important too don’t fold your arms, don’t zawn when talking to them, don’t give poor contact and open arm posture. They will feel like their boring you and you’re not interested and won’t build a steady professional relationship with you.

Through studying at university, I now feel I have a better understanding that having a professional relationship with patients are important to have as you will achieve a more successful patient and family centred care. Person – centred care and family centred care is a high priority in all health care professions. It’s all about making sure that people are involved and is central to their care and needs. McCormack and McCance (2017) suggest that that creating relationships its essential when creating person centred care. These relationships are not only with the patient or families it’s also about the relationship you have with other healthcare professionals. KS Dunham (2018) gives out suggestions that Communication is also key when it comes to colleagues as a nurse or any healthcare professional you will probably communicate most with them. Having professional relationships with colleagues’ help set the groundwork for successful inter-learning which is critical to delivering care. Person-centred Practice in Nursing and Health Care is a comprehensive and practical resource for all nurses and healthcare practitioners who want to develop person-centred ways of working.

Communication is essential in health care, it wouldn’t be person centred care without it. RCN (2018) say ‘having a good communication with patients will reduce their anxiety and build their confidence’. It’s common for patient to feel anxious about their care, treatments or even tests they are getting whilst in your care. It can sometimes lead to the patient to speak out of character, be rude or even aggressive as they are unsure what the future holds for them, this is just down to them being scared and not sure what is happening. Communication with the nurse or health care professional will prevent this if you let them know what’s happening and if you don’t know tell them and they will find out as soon as you do. It’s hard for patients in hospital or care homes because they are usually in control of their everyday tasks and as an elderly person, they might have dementia or just not as able as they used to be and don’t like that they need someone to help them out of bed, help them when they wash or even eat. Losing control can make them feel helpless or hopeless. But good communication can avoid these feelings if the patient is able to still take charge of their own life. It can help people to see that they still have a say and are still in charge of their own lives. Patients that get good communication with healthcare professionals often feel more valued than the patients that don’t. Giving patients our time and spending time with them, getting to know them and listening to them, we’re showing that we value what their saying and communicating with them will help us achieve the best person-centred care they need.

The department of health (2011) state that personal values are your own individual beliefs. Attitudes, behaviour, life experiences and decision making. Everyone has their own values and attitudes in life but as a nurse you have to put your own values and attitudes aside for the care of your patient. Journal of Professional Nursing (2005) states that our values are hierarchy based and therefore nurses should recognize that another’s personal values might differ from their own. Being brought up in different generations can cause conflict with as the older generation may think that they but as a nurse you have to put values to the side to care for your patient. NMC (2018) say in the national care standards, ‘Treat people as individuals’ as you must not discriminate in any way against those in your care. Nurses practise in diverse cultural environments and must take care not to offend patients’ values and beliefs.

One of the values I have in life is Health, I think health is very important because if we didn’t have our health, we wouldn’t have a normal standard of life as having bad health would stop that. As a nurse I have to be professional and put my attitudes and opinion aside as not everyone thinks the same. I’ve also got to be very supportive with my patients and help them regardless of their issues and thought progress. As a mental health nurse I know I am going to come across patients that don’t want help regarding their health due to substance abuse, suicidal attempts and then on the other hand I will come across an elderly patient with the first symptoms of dementia and they don’t have a choice in life regarding their health but try their best to get back to a normal life as possible. Alzheimer’s Scotland (2018) state that dementia is progressive meaning that the symptoms start out slower but gradually get worse. For people with dementia this means their memory becomes worse and their health can start to deteriorate which upsets them and their family around them.